I.Identity Name: Mr..S Age: 50 yr Gender: male Religion : Islam Occupation: Self Employed Address: Plumbon Date of admission: 23 - 10-2012 Date of inspection: 25 - 10-2012 II. Anamnesis (Autoanamnesis dated 25-04 - 2010) The main complaint: Abdominal pain Additional complaints: Defecation hard already 1 week, can not fart 1 week, nausea (+), urination no complaints History of present illness Patients come to the hospital with complaints of pain Arjawinangun abdominal arteries radiating area towards the back.Pain is felt 5 days SMRs. And the pain is intermittent nor continuous. Also found nausea and vomiting, vomiting occurred twice. Patients also complain t o be flatus and bowel 1 week SMRs.Ien te pas Stomach bloating also.BAK patients LANC a r.Fever is not felt by the patient. History of the disease before Hypertension (-), DM (-) 1 light reflex + / + Thorax Cast: Inspection: ICTUS cordis is not visible Palpation: ICTUS cordis palpable Percussion: limit of normal heart Auscultation: BJ I-II regular. gallop Pulmo: Inspection: hemitoraks movement of the right and left symmetric Palpation: vocal and tactile fremitus hemitoraks symmetrical right and left Percussion: resonant throughout the lung fields Auscultation: vesicular.7 Head: normocephal Eyes: Conjuctiva not anemis and jaundice.III. wheezing .Physical examination Status generalist General condition: Looks sick were Awareness: compos mentis Vital sign: Tension: 90/60 Pulse : 90 Respirasi: 28 x Temperature : 36./ -. rhonki ./ Abdomen Inspection: Not seen any time Palpation: Tenderness + Percussion: Timpani 2 . murmur -. isokor round pupil. Acute Appendicitis VI .Obstruction Ileus 2. and the picture does not look peritonitis V.Auskulltasi: Noisy intestine increased Genitals: no abnormalities Extremities: warm Akral. Differential Diagnosis 1./ - IV. edema . Acute Gastroenteritis 4.Management Infusion Rl Cefotaxime 3 . Paralytic ileus 3.Working Diagnosis Obstruction Ileus VII.Examination Support Routine blood Lab Hb: 6.4 Platelets: 367 KGDS: 89 mg / dl Radiological examination image obtained ilues loka middle abdomen.38 Leukocytes: 17.4 RBC: 2. Prognosis Ketorolac Ranitidine Dulcolax Quo ad Vitam: Dubia ad Bonam Quo ad functionam: Dubia ad Bonam 4 .VIII. and hemorrhagic. After turning a complete 270 º from the starting point. Intestinal obstruction is a disorder in both peristalsis in the colon and small intestine. herniation of intestine was happening until the umbilicus. Most of the obstruction it affects the small intestine. Barriers can be caused by the passage of intestinal obstruction or intestinal lumen by peristalsis disturbance. partial or total.2002).average age around 16-98 years. Round the middle intestine has two branches namely cranial and caudal. Based on research conducted by Markogiannakis et al (in 2001 . the length rises rapidly.Endodermal layer to form the epithelial lining of the digestive tract and splanchnic mesoderm around endermal form of muscular connective tissue and other intestinal lining. Athens experienced ileus obstruction and average .70% of all cases of acute abdomen. invagination or blockage in the intestinal lumen.Ileus Obstruction Intestinal obstruction is abdominal surgical emergencies in a common and account for 60% . when the intestines back into the abdominal cavity. ischemic. During the fourth week of fetal development.men. proximal two-thirds of the transverse colon. Acute abdomen may be caused by abnormalities in the abdomen in the form of inflammation. Bowel obstruction or ileus called obstruction (mechanical obstruction) for example. Ileus is two ileus obstruction and paralytic ileus. Dynamic ileus can be caused by excess dynamic like spasms. Embryology Intestinal primitive form since the fourth week of fetal development. Bowel obstruction can be acute or chronic. Cranial branch evolved into the distal duodenum. While branch caudal to distal ileum. Some disorders can be caused by direct or indirect injury resulting in perforation or gastrointestinal bleeding sa Luran. and ileum proximal jejenum. and penyulitnya. Bowel herniation was happening until the age of 10 weeks' gestation fetus. where the primitive gut comes from the middle intestine. Chronic intestinal obstruction is usually about as a result of colon carcinoma. outside the gut and in the intestinal lumen. Unless the duodenum. by strangulation. found 60% of patients who were treated at Hippokration Hospital. Total obstruction of the small intestine is gravity that require early diagnosis and emergency surgery. with a sex ratio of more women than men . Mechanical obstruction may be due to a lesion in the intestinal wall. obstructive ileus. the proximal portion jejenum back into 5 . Ileus is a disruption passage of intestinal contents is a sign of acute intestinal obstruction requiring immediate aid or action. 2. This ligament acts as a suspensory ligament.Intestine with superior mesenteric artery and vein in the mesentery would. Kira . General Secretary of the last entry and its location in the right upper quadrant. The duodenum about 25 cm in length. descending colon and sigmoid were diperdarahi by a. distal to the left. Intestine after rotating 90 º. Separation duodenum and jejenum characterized by Treitz ligament. muscularis propria. Muscularis propria layer consists of two layers 6 .the abdomen and occupies the left side of the abdomen with the next ring occupies the right. while the cecum with spin in the ventral colon to the right. and submucosa layers mucosal lining. After a complete rotation (270 º) In embriologik. 1. whereas the left colon to the rectum comes from the hindgut. right colon from the middle intestine. Malrotation congenital intestinal anomalies can occur in this process. In the development of the disorder sometimes occurs embriologik embryonic gut rotation so that the right colon and cecum have a free mesentery. Long jejenum 100-110 cm and a length of 150 -160 cm ileum.mesenterika superior. the cecum on the right is still down to the bottom right. Serous layer is the outermost layer that consists of the parietal peritoneum and visceralis and space that lies between the visceral and parietal layers called the peritoneal cavity.about two-fifths of the remaining small intestine is jejenum. This situation facilitates the rotation or volvulus most common intestinal mesentery as can occur with long roots in the sigmoid colon with a narrow. which is at the apex cecum. and ileum jejenum. namely serous layer. Phase embryology and levels of intestinal rotation 1. Located in the proximal part of the right. 3. and three-fifths are terminal ileum parts. although in the end the cecum will drop to its normal position in the right lower quadrant.mesenterika superior. the intestinal wall is divided into four layers. The small intestine is divided into duodenum. Round continues. In microscopy. ANATOMY The small intestine extends from pylorum to caecum length 270 cm to 290 cm. from the pylorus to jejenum. Duodenal next round dorsal a. Hindgut formed part transverse colon. Appendix vermiformis appendix is a tube measuring around your little finger ileosekal located in the area. Jejenum have great vascularity which are thicker than ileum. Lesser omentum is a fold of peritoneum extending from curvatura minor stomach and upper duodenum to the liver. Kolon subdivided into ascending colon. colon descendens. combined with the splenic vein to form the portal vein. These arteries mendarahi entire small intestine except duodenum diperdarahi by gastroduodenalis artery and superior pancreaticoduodenal artery branches. Submucosa layer consists of a layer of connective tissue fibroelastis that contains blood vessels and nerves. The large intestine is divided into caecum. Caecum occupies approximately the first two or three inches of the colon. and sigmoid descenden. Sigmoid colon from the iliac crest height and shape of an S-shaped curve Angled bottom while turning left sigmoid colon to the rectum together.kolika media. which hangs like a fan jejenum and ileum from the posterior abdominal wall. while the parasympathetic nerve fibers regulate intestinal reflexes. The left transverse colon. colon and rectum. Omentum usually contain a lot of fat and lymph nodes that help protect against infection peritoneal cavity. transverse colon. Sensory nerve fibers of the sympathetic system delivers pain. Stimulate the parasympathetic stimulation of secretory activity and movement. The blood is returned through the superior mesenteric vein. Mesentery is a broad fold of peritoneum. Mayus omentum is a peritoneal lapisanganda mengantung of curvatura major stomach and goes down in front of the abdominal viscera. Mucosal layer is divided into 3 layers of muscularis mucosa. Cecum. sigmoid colon and rectum perdarahi largely by inferior a. Superior mesenteric artery branched from the aorta just below celiaca artery. The large intestine has four layers of morphologic like other parts of the intestine.of longitudinal muscle is a thin muscle layer and a thick layer of circular muscle. lamina propria and epithelial layer.kolika right and a. whereas sympathetic stimulation inhibits bowel movements. a. Ganglion cells derived from Myenterica plexus (Auerbach) that sits between the muscle layer and sends stimulation to the second layer. Mucosal and submucosal layers form a circular layer called valvula koniventes (Lig. The place where the colon to form a sharp turn to the right and left upper abdomen respectively called the hepatic flexure and the splenic flexure.ileokolika.mesenterika a.mesenterika through 7 . Innervated intestine both branches of the autonomic nervous system. In the caecum and appendix ileosekal valves are attached to the end of the caecum.Kerckringi) that protrude into about 3 mm. ascending colon and transverse colon to the right diperdarahi by the superior branch a. forming Hepatogastrikum ligament and ligament hepatoduodenale. enzymes present in brush border villi and assimilate substances . The presence of bicarbonate in the pancreatic secretion help neutralize acids and provide an optimal pH for the enzyme . Kolon innervated by the sympathetic fibers from plexus n. water. In addition. Bowel movement consists of: 1. Colonic veins run parallel to arteries. fats.a. and proteins into substances . hepatobiliar and intestinal secretions and peristaltic movements propel contents from one end to the other with a speed that is appropriate for optimal absorption and continuous supply of gastric contents. Muscles that primarily contribute to the segmentation contractions to mix food is longitudinal muscle. Each contraction involves a segment of intestine approximately 1-4 cm. Secretion of bile from the liver to help digestion by emulsifying fats thus providing more surface area for pancreatic lipase work. The process continues in the duodenum. especially by the action of the enzyme . Many of the enzymes . hydrochloric acid and pepsin to food intake. Propulsif peristalsis movement or the push food to the large intestine.hemoroidalis superior. fats and proteins through the intestinal wall into the blood and lymph circulation to be used by the cells . a. electrolytes and vitamins are also absorbed.nutrients.nutrients while absorbed.vagus. When part distends the food. Contraction of the small intestine caused by the activity of intestinal smooth muscle consists of 2 layers of the longitudinal muscle layer and the circular muscle layer.kolika sinistra.sigmoid and a. Segmental bowel movement will mix substances eaten with pancreatic secretions. The process of digestion begins in the mouth and stomach by working ptialin. electrolytes and minerals. the intestinal wall to contract locally.splanknikus and presakralis and parasympathetic fibers derived from N. water.the body's cells.substances that are more simple. The movement of bowel function for the digestion and absorption of ingredients . Movement mixing (mixing) or segmenting movement that mixes food with enzymes the digestive enzymes to be easy to digest and is absorbed 2.food can run optimally. Absorption is the transfer of the final results of the digestion of carbohydrates. PHYSIOLOGY The small intestine has two main functions of digestion and absorption materials .enzymes that hydrolyze pancreatic carbohydrates. At the time the contract segment of the small 8 . The digestion process is accomplished by a number of enzymes in the intestinal lymph (sukus enterikus).enzymes. This movement is repeated continuously so the food will be mixed with digestive enzymes and make contact with the intestinal mucosa and subsequent absorption occurs. Ileocaecal sphincter function regulated by a feedback mechanism. Upon reaching the ileocaecal valve. and insulin also increase bowel movements. This is largely due to the entry of food into the duodenum. Instead sekretin and inhibit glucagon bowel movements. food sometimes . which is faster in the proximal than the distal. serotonin.intestine that undergo relaxation. In addition.the cell is affected by the nervous and hormonal systems. causing peristaltic reflex that will spread to the intestinal wall. the increased activity of the peristaltic reflex gastrileal and push food through the colon leading to the ileocaecal valve. If there is inflammation of the caecum or the appendix the ileocaecal sphincter spasm will experience. When the pressure in the caecum increases resulting in dilation. CCK. the hormone gastrin. namely extraluminal obstruction. Extraluminal obstruction such 9 . where the activity of the cell . The process of segmentation contraction lasts 8 to 12 times / min in the duodenum and about 7 times / min in the ileum. Segmentation contractions lasted because of the slow wave which is the basic electric rhythm (BER) of the gastrointestinal smooth muscle.5 to 2 cm / sec. At the moment. the ileocaecal sphincter contraction increases and ileum peristalsis is reduced thereby slowing the emptying of the ileum. Peristalsis in the small intestine to push food toward the colon with a speed of 0. Peristaltic activity will increase after eating. Ileocaecal valve serves to prevent the food back from the caecum into the ileum. the food will be returned to its original position. Food was settled for a time in the area ileum by the ileocaecal sphincter function so that the food can be absorbed in this area.sometimes blocked for several hours until someone eating again. and so on. Peristalsis is very weak and usually disappear after takes approximately 3 to 5 cm Setting the frequency and strength of the movement segmentation mainly governed by the slow wave that produces the action potential caused by the presence of cells . and the ileum will experience paralysis so pengosonga ileum severely hampered. intrinsic obstruction and intraluminal obstruction. Etiology The cause of obstruction in the small intestine can be divided into three. When the small intestine relaxes.pace maker cells found in the intestinal wall. other segments will soon start contractions. 6 Causes of Obstruction Ileus Lesions extrinsic to the bowel wall (postoperative) Hernia (inguinal. The cause can be seen in the table below. Disease. Diverticulitis) Neoplasms Traumatic Intusepsi 6 10 . Adhesions femoral. Intrinsic obstruction of the intestinal wall as the primary tumor. gallstones and foreign bodies. hernia. umbilical) Neoplasms Intraabdominal abscess Intraluminal obstruction Gallstone Enterolith Lesions intrinsic to the intestinal wall cyst) Inflammation (Crohn's Congenital (Malrotation. And as enteroliths intraluminal obstruction.as adhesion. carcinoma and abscess. barrier passage appears without vascular and neurologic disturbances. inkarserata hernia and colon malignancies most frequently cause obstruction. Severe intestinal distension 11 .Adhesion. Increased intraluminal pressure and the presence of vascular distension caused disruption especially venous stasis. appendectomy and colorectal resection. peristalsis in the proximal colon increased to fight the resistance. Toxin production caused by the translocation of bacteria causing systemic symptoms. regardless of whether the obstruction was caused by a mechanical or functional causes. If there is an increase in intraluminal pressure. The main difference is the mechanical obstruction (ileus obstruction) the peristaltic first . While in paralytic ileus. In simple mechanical obstruction. where the frequency depends on the site of obstruction. where an increase in intraluminal pressure. Secretory function and decreased intestinal absorption of mucous membranes and intestinal wall edema and congestion becomes. Intestinal wall into edema and bacterial translocation occurs to the blood vessels. peristalsis from the beginning is not there. Local effect stretching the colon is due to ischemic necrosis with absorption of toxins of bacteria into the peritoneal cavity and systemic circulation. intestinal secretions and air would gather in large numbers if obstruksinya complete. hypersecretion will increase when the intestinal absorption capacity decreases. Adhesions can form adhesions may be in the form of single or multiple. Food and liquids are ingested. which is the most common cause adhesion gynecologic surgery. onset occurs arrived . on adhesion. Initially. Adhesion is generally derived from the peritoneal cavity due to local or generalized peritonitis or postoperatively.Of the 60% of cases of ileus obstruction in the USA. Ileus due to adhesion is generally not accompanied by strangulation. Pathophysiology Patofisiologik events that occur after bowel obstruction is the same. Patofisiologik changes in bowel obstruction can be seen in the table below.arrived with complaints of abdominal bloating and abdominal pain. the proximal part of the intestine will not contract properly and bowel become disorganized and lost. Patofisiologik mechanical bowel obstruction associated with changes in the function of the intestine. If there is obstruction the proximal part of the intestine distends and containing gas.then a strong first intermittent and then disappeared. fluid and electrolytes. The ongoing peristaltic activity causing rupture. resulting in a substantial loss of volume and progressive systemic. If the obstruction persists and an increase in intraluminal pressure. Proximal part of the intestine distends and the distal collapse. continuous and progressive will disrupt peristalsis and mucosal secretory function and increase the risk of dehydration.sometimes can be increased. ischemia. The presence of blood in feces mixed toucher rectal examination can be suspected of malignancy and intusepsi. which is then followed by occlusion of the artery. Obstruction of the colon usually have a milder clinical symptoms than small bowel obstruction. In the proximal small bowel obstruction symptoms are usually vomiting. Body temperature is usually normal but sometimes . In the advanced stage where the obstruction continues. Along with the loss of fluid and electrolytes. tachycardia. On examination of the abdomen seemed distended abdomen obtained and peristaltic increases (sound Borborigmi). necrosis. Fever indicates obstruction strangulate. peristaltic will weaken and disappear. accelerate intestinal become gangrene and perforation. and severe symptoms of dehydration. peritonitis and death. nausea.sometimes dilatation of the bowel can be palpated. Examination Support 12 . usually originated from venous obstruction. abdominal distension and can not defecate (obstipasi).by itself on a continuous . Obstruction of the small intestine causing symptoms such as abdominal pain around the umbilicus or the epigastrium. vomiting. DIAGNOSIS Clinical Symptoms The main symptoms of ileus obstruction include colicky abdominal pain. dehydration will occur with clinical manifestations of tachycardia and postural hypotension. At this early stage. Generally. symptoms of constipation ended obstipasi and abdominal distension. When the location of the obstruction in the distal part of the dominant symptom is abdominal pain. Patients with partial obstruction may develop diarrhea. normal vital signs. Abdominal distention occurs when obstruction persists and the proximal part of the intestine becomes very dilated. Strangulated obstruction. perfo constellation. Nausea and vomiting are common in high obstruction lies. From the physical examination found the presence of fever.Vomiting is rare. hypotension. Edema and necrosis of the intestine. causing a rapid ischemic bowel wall. If the obstruction is located in the middle or high location of the small intestine (ileum and proximal part jejenum) it is constant pain / settle. Sometimes . Abdominal pain is intermittent or variable and colic with the up and down pattern. aspiration of the vomit and died. ureteric colic. Increased hematocrit can occur in dehydration. shock-dehydration. In the early stages. pneumonia. dehydration and ketosis. it can be found electrolyte disturbance. 13 . Increased serum amylase is often obtained. and metabolic acidosis when there is a sign . Radiological Dilatation of the colon with the picture "step ladder" and "water fluid levels" in plain abdomen can be concluded that the presence of an obstruction. CT scans sometimes . If stangulasi and necrosis occurs. leukocytosis and abnormal electrolyte values. pelvic fractures and after abdominal surgery.44% in non Strangulated obstruction. it was found that normal laboratory results. pain is usually not too heavy and more constant. Blood gas analysis may be impaired. Subsequently found any hemoconcentration. but only occurs in 38% . whereas sensitivity of 84% in colonic obstruction. Plain abdomen have a higher sensitivity of 66% in small bowel obstruction. Diagnosis APPEAL Ileus may be caused by processes in intraabdominal and retroperitoneal. COMPLICATIONS Complications that can arise such as bowel perforation. Leukocytosis indicate ischemic or strangulated. The use of contrast is not recommended because it can cause peritonitis due to perforation. but it helps provide an assessment of the severity and assist in resuscitation. In plain abdominal match picture "step ladder and air fluid levels" especially at the distal obstruction.Laboratory Laboratory tests have limited value in establishing the diagnosis. including ischemic bowel. Free air on upright thoracic photo showed a bowel perforation. In case of paralytic ileus. Moreover.50% compared to 27% of strangulation obstruction . with metabolic alkalosis when severe vomiting. it will be a picture of a regular muosa loss and the presence of gas in the intestinal wall. sepsis. In the colon may not seem gas.sometimes used for diagnosis in small bowel obstruction to identify patients with complete obstruction and bowel obstruction is suspected abscess or malignancy.a sign of shock. abscesses. MANAGEMENT Basic treatment of obstructive ileus is a correction of electrolyte and fluid balance. Operative action can be sealed ukan obstruction exactly ten though partial.In obstruks i partial repeat difficult to determine whether or not operative action. patients with radiation therapy.Surgery is sometimes difficult to do because kemungkainan rid of strangulation obstruction. ischemic enteritis or mesenteric vascular obstruction associated with venous thrombosis. overcoming peritonitis and shock if present.Obstipasi and distention of abdomen showed a large bowel obstruction. Ileus obstruction should be distinguished from paralytic ileus. Decompression by nasogastric tube successfully in 90% of patients. patients with a history of surgery for obstruction. in some cases. inflammation of the intestines and abdominal carcinoma. eliminating stretching and vomiting with decompression. Pharmacological Medications . Operative Preparation 14 . acute appendicitis and acute pancreatitis. and remove the obstruction to improve the viability and bowel function returned to normal Partial obstruction can be managed conservatively as long as there defecation and flatus. Surgeons must remain alert to the signs and symptoms improved after resuscitation without exception. Antiemetic may be given to reduce the symptoms of nausea and vomiting. Strangulation obstruction have a complaint similar to acute pancreatitis. such as partial obstruction. Therapy is usually much nonoperatif selected patients.broad-spectrum antibiotics can be administered as a prophylactic. especially with the possibility of complications and death in stranguasi. postoperative obstruction.Some of these cases took first thought. Small bowel obstruction can be confused with acute gastroenteritis. Surgery should not be decided quickly. Diagnosis can be established based on the results of x-ray photo showing the obstruction dilatation of the proximal colon. Total small bowel obstruction treated with operative action after preparation. Vomiting is infrequent and non-colicky pain. Time to dilakuakan bergatung opertif action on the state of the patient. Nasograstik tube. dehydration and shock. Patients should be provided with strangulation obstruction or blood plasma. The amount of fluid and electrolytes needed to be estimated for each patient. 1. Antibiotics should be given if strangulation is suspected. and the lack of mechanisms to correct this imbalance neuroendrokin.vital signs and the amount of urine to leak. Nasogastric tube in pairs to reduce vomiting. Loss of isotonic fluids should be initiated with intravenous isotonic saline solution. Here are some condition or consideration for surgery. Resusiatasi fluid and electrolyte In resuscitation to note is overseeing signs . The risk of strangulation to be considered despite the abnormal state of the fluid and electrolyte and the need to evaluate the systemic disease. Operation The operation is performed after rehydration and nasogastric decompression to prevent secondary sepsis. Gastrointestinal fluid loss is the cause of acid-base balance disorders. Lack of fluid and electrolyte depends on the type and duration of obstruction. then we need to correct first. Response to therapy can be seen by monitoring signs . Hemoconcentration that occurs in longstanding obstruction that can not be simply corrected with dextrose solution alone. meghindari occurrence of aspiration. The operation begins with a laparotomy was followed by surgical techniques that are tailored to the results of exploration during laparotomy. and to reduce the amount of air in the lumen of the gut that makes abdominal distention.Patients who develop ileus obstruction dehydrated and balance disorders ektrolit that needs to be given intravenous fluids such as Ringer's lactate. Patients can not be operated if uncorrected hypokalemia. 2. Clinical features and association with systemic diseases also need to be monitored. 15 . Examination of serum electrolytes and blood gas analysis may help to decide which elektrotit therapy should be given.vital signs. Adesiolisis laparaskopi dilakuakan can also in some patients with the utmost care. pulsation mesentrikanya and peristaltiknya a few minutes later. Gangreneus intestine should be resected. The use of intraoperative Doppler ultrasound is a method to see whether or not the part is still viable bowel obstruction. Anastomosis of the proximal small bowel obstruction distal to the obstruction of the 16 . Standard in inguinal incision can be performed in patients with a femoral hernia and inkaserata ingunalis. and obstruction because alineum corpus should be disposed enterotomi. strangulated hernias Peritonitis Pneumatosis cystoides intestinalis Pneumoperitoneum Suspected or proven intestinal strangulation Closed-loop obstruction Nonsigmoid colonic volvulus Sigmoid volvulus associated with toxicity or peritoneal signs Complete bowel obstruction Situations necessitating urgent operation Progressive bowel obstruction at any time after nonoperative measures are started Failure to improve with conservative therapy within 24A € "48 hr Early postoperative technical Complications Situations in roomates Usually delayed operation is safe Immediate postoperative obstruction But in strangulation obstruction. Loop soaked with warm saline solution and see color. toxic effects to make the operation should be performed. but it is difficult to determine whether the gut is still viable or not. obstruction of the tumor resection can be performed. Ekstirpasi obstructive lesions can not be performed in patients with carcinoma or radiation injury.Situations necessitating emergent operation Incarcerated. 1000mg florosein in injected into a peripheral vein for 30-60 minutes which will be seen in ultraviolet light (Wood's lamp). operative procedures on the cause of obstruction. If the results were non-viable resection end-to-end anastomosis is the safest. On the obstruction on the adhesion should be adhesiolisi. Florosein qualitative test can help. Pencegahn adhesion to hyaluronic acid bioabsorbable barrier methylcellulose proven effective in lowering the incidence and forms dahesi reopeatif. either because the disease itself or because of an infected person. To prevent adhesion formation by sewing uncontrolled bowel loops that fit together menjadiakan can not show success. Sometimes adhesion occurs very thick so it does not do the separation and dialkukan anastomosis can not be perfect. for example in non-strangulated hernia incarcerata. Prognosis Strangulated obstruction without mortality was 5% to 8% as long as the operation can be done immediately. Long decompression with tube or tube gastrotomi jejunostomi and pemeberian makana via parenteral be menjadaikan spontaneous healing for several weeks. invagination. later on bowel resection and anastomosis. sometimes done gradually operative action. The prognosis is good if the diagnosis and the action is fast.small intestine or colon (baypass) is probably the best procedure for these patients. for example at an advanced stage Ca. Delay in performing surgery or in case of strangulation or other complications will increase the mortality to about 35% or 40%. (C) Make entero-cutaneous fistula in the proximal part of the obstruction. for example in carcinomacolon. Crohn's disease. Generally known 4 types (way) surgery is done on the obstruction ileus. (A) Correction simple (simple correction). This is a simple surgery to rid the intestines of tongs. Creating a new gut "through" the colon is clogged. Decompression on the massive bowel dilatation facilitate abdominal closure and reduction of postoperative healing period. Strangulated. and so on. eg intralurninal tumors. first performed a colostomy only. Decompression done by entering the long tube through oral or by needle aspiration of the intestinal wall. and so on. (D) Perform a clogged bowel resection and anastomosis make ends intestinal lumen to maintain the continuity of the intestine. such as the Ca obstructive sigmoid. (B) Measures operative by-pass. In some obstruction ileus. tongs by streng / adhesion or mild volvulus. 17 . 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